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, 23 (19), 3546-3555

Nissen Fundoplication vs Proton Pump Inhibitors for Laryngopharyngeal Reflux Based on pH-monitoring and Symptom-Scale

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Nissen Fundoplication vs Proton Pump Inhibitors for Laryngopharyngeal Reflux Based on pH-monitoring and Symptom-Scale

Chao Zhang et al. World J Gastroenterol.

Abstract

Aim: To compare the outcomes between laparoscopic Nissen fundoplication (LNF) and proton pump inhibitors (PPIs) therapy in patients with laryngopharyngeal reflux (LPR) and type I hiatal hernia diagnosed by oropharyngeal pH-monitoring and symptom-scale assessment.

Methods: From February 2014 to January 2015, 70 patients who were diagnosed with LPR and type I hiatal hernia and referred for symptomatic assessment, oropharyngeal pH-monitoring, manometry, and gastrointestinal endoscopy were enrolled in this study. All of the patients met the inclusion criteria. All of the patients underwent LNF or PPIs administration, and completed a 2-year follow-up. Patients' baseline characteristics and primary outcome measures, including comprehensive and single symptoms of LPR, PPIs independence, and satisfaction, and postoperative complications were assessed. The outcomes of LNF and PPIs therapy were analyzed and compared.

Results: There were 31 patients in the LNF group and 39 patients in the PPI group. Fifty-three patients (25 in the LNF group and 28 in the PPI group) completed reviews and follow-up. Oropharyngeal pH-monitoring parameters were all abnormal with high acid exposure, a large amount of reflux, and a high Ryan score, associated reflux symptom index (RSI) score. There was a significant improvement in the RSI and LPR symptom scores after the 2-year follow-up in both groups (P < 0.05), as well as typical symptoms of gastroesophageal reflux disease. Improvement in the RSI (P < 0.005) and symptom scores of cough (P = 0.032), mucus (P = 0.011), and throat clearing (P = 0.022) was significantly superior in the LNF group to that in the PPI group. After LNF and PPIs therapy, 13 and 53 patients achieved independence from PPIs therapy (LNF: 44.0% vs PPI: 7.14%, P < 0.001) during follow-up, respectively. Patients in the LNF group were more satisfied with their quality of life than those in the PPI group (LNF: 62.49 ± 28.68 vs PPI: 44.36 ± 32.77, P = 0.004). Body mass index was significantly lower in the LNF group than in the PPI group (LNF: 22.2 ± 3.1 kg/m2vs PPI: 25.1 ± 2.9 kg/m2, P = 0.001).

Conclusion: Diagnosis of LPR should be assessed with oropharyngeal pH-monitoring, manometry, and the symptom-scale. LNF achieves better improvement than PPIs for LPR with type I hiatal hernia.

Keywords: Gastroesophageal reflux disease; Hiatal hernia; Laparoscopic Nissen fundoplication; Laryngopharyngeal reflux; Proton pump inhibitor; pH-monitoring.

Conflict of interest statement

Conflict-of-interest statement: The authors of this manuscript having no conflicts of interest to disclose.

Figures

Figure 1
Figure 1
Comparison of the laryngopharyngeal reflux symptom score between the laparoscopic Nissen fundoplication and proton pump inhibitor groups before treatment and at the 2-year follow-up. Range, upper and lower quartiles, and median values are shown. Represents significant P values (aP < 0.05) for a difference in improvement of symptoms between the LNF and PPI groups. P values are also shown in the right lower corner of each box. LNF: Laparoscopic Nissen fundoplication; PPI: Proton pump inhibitor.
Figure 2
Figure 2
Comparison of the typical gastroesophageal reflux disease symptom score between the laparoscopic Nissen fundoplication and proton pump inhibitor groups before treatment and at the 2-year follow-up. Range, upper and lower quartiles, and median values are shown. Represents significant P values (aP < 0.05) for a difference in improvement of symptoms between the LNF and PPI groups. P values are also shown in the right lower corner of each box. LNF: Laparoscopic Nissen fundoplication; PPI: Proton pump inhibitor.

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